P1146: TRANSFUSION NEEDS AFTER CD19 CAR T-CELLS FOR LARGE B-CELL LYMPHOMA: PREDICTIVE FACTORS AND IMPACT ON OUTCOME. A DESCAR-T STUDY.
Authors: Samuel Vic, Jean-Baptiste Thibert, Emmanuel Bachy, Guillaume Cartron, Thomas Gastinne, Ibrahim Yakoub-Agha, Fabien Le Bras, Kamal Bouabdallah, Fabien Despas, Jacques Olivier Bay, Marie-Thérèse Rubio, Mohamad Mohty, Rene Olivier Casasnovas, Sylvain Choquet, Cristina Castilla-Llorente, Stephanie Guidez, Michael Loschi, Blandine Guffroy, Sylvain Carras, Laurianne Drieu La Rochelle, Roch Houot
Journal: HemaSphere (2023)

Topic: 19. Aggressive Non-Hodgkin lymphoma - Clinical Background: Chimeric antigen receptor (CAR) T-cells targeting CD19 are approved for the treatment of relapse or refractory large B-cell lymphoma (LBCL). Patients undergoing CAR T-cell therapy may experience cytopenias due to lymphodepleting chemotherapy and/or CAR T-cells, and may require red blood cells (RBC) and/or platelets transfusions. Transfusion needs represent a surrogate marker of severe cytopenias after CAR T-cell therapy, and may impact patients’ quality of life. Transfusions may also impact CAR T-cells efficacy through transfusion-related immunomodulation (TRIM). Aims: To describe the transfusion needs of patients receiving commercial CD19 CAR T-cells for LBCL, identify predictive factors associated with transfusion needs and search for correlations between transfusions and CAR T-cells efficacy. Methods: Clinical data were collected form the DESCAR-T registry, the French national real-life registry for all patients treated with commercial CAR T-cells. Transfusion data were collected from the French national blood bank. Merging these two databases allowed us to study the relationship between CAR T-cell therapy and transfusions. We included all patients infused with commercial CAR T-cells for LBCL with at least 6-months follow-up. Patients were censored for transfusions at relapse, new treatment onset, or death. Results: Between August 2018 and September 2022, 671 patients registered in the DESCAR-T registry met the eligibility criteria: 429 (63.9%) treated with Axi-cel and 242 (36.1%) with Tisa-cel. At the time of infusion, median age was 63 years, 15.3% of patients had a performance status (PS) ≥ 2, and 45.6% were refractory for first line therapy. Median number of prior lines was 2, 17.6% had received a prior autologous stem cell transplantation (ASCT). Overall, 82.7% of patients received bridging therapy, including 69.9% chemotherapy. The CAR-HEMATOTOX score was 0, 1 or ≥2 in 32.9%, 37.8% and 29.3% of patients, respectively. Overall, 382 patients (56.9%) received at least one transfusion after CAR T-cell infusion. The mean number of RBC and platelets transfusion per patient were 3.5 (range, 0-90) and 5.1 (range, 0-127), respectively. At the early phase (i.e. within the first month), 359 patients (53.5%) received at least one transfusion: 317 (47.2%) patients received RBC and 252 (37.6%) patients received platelets transfusions. At the late phase (i.e. beyond one month), 208 patients (37.8%) received at least one transfusion (32.5% RBC and 33.3% platelets). Factors associated with transfusion needs after CAR T-cells therapy are presented in Table 1. Interestingly, age, primary refractory status, prior ASCT, and severe CRS were associated with early but not late transfusion needs. No association was found between transfusions and best overall response rate. However, early transfusions (RBC and/or platelets) were associated with a shorter progression-free survival (median PFS = 3.2 vs 6.0 months, p=0.0168) and overall survival (median OS = 9.3 vs 23.6 months, p<.0001). Late platelets transfusions were associated with decreased PFS (median = 5.6 vs 12.0 months, p=0.0072) and OS (median = 13.8 vs not reach, p<.0001) whereas late RBC transfusions did not impact PFS nor OS. Summary/Conclusion: In our study, 56.9% of patients received transfusions after CAR T-cell therapy, including 53.5% during the first month and 37.8% beyond. We identified risk factors associated with early and late transfusion needs. Early transfusions (RBC and platelets) and late platelets transfusion (but not late RBC transfusion) were associated with worse survival (PFS and OS).Keywords: CAR-T, Blood transfusion, Diffuse large B cell lymphoma